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Abstract: FR-PO809

Serum Globulin and All-Cause Mortality in Hemodialysis Patients

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Kim, Joseph, Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California, Irvine, Orange, California, United States
  • Park, Christina, Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California, Irvine, Orange, California, United States
  • Hsiung, Jui-Ting, Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California, Irvine, Orange, California, United States
  • Naderi, Neda, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
  • Rhee, Connie, Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California, Irvine, Orange, California, United States
  • Kovesdy, Csaba P., University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Kalantar-Zadeh, Kamyar, Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California, Irvine, Orange, California, United States
  • Streja, Elani, Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California, Irvine, Orange, California, United States
Background

Nutritional status and inflammation are significant markers for mortality and morbidity, especially in hemodialysis patients. While there is much evidence to support the association between albumin levels and nutritional status and inflammation, less is known about the associations between globulin levels and mortality risk in hemodialysis patients.

Methods

We retrospectively examined a cohort of 104,164 incident hemodialysis patients treated by a large dialysis organization from 2007 to 2011 whose first patient quarter (dialysis start + 91 days) globulin measurements were obtained during treatment. Patients were grouped into 9 globulin categories. Using Cox models, we explored the association between serum globulin levels and all-cause mortality from the time of dialysis initiation with adjustments for case-mix variables and laboratory markers of malnutrition inflammation complex syndrome (MICS), including albumin.

Results

Mean patient age was 63±15 years; 44% were female, 31% were African American, and 58% were diabetic. Mean globulin level was 1.16±0.31 g/dL. Compared to the reference group of 3.0-<3.2 g/dL, patients with lower globulin (<2.8 g/dL) and higher globulin (≥3.8 g/dL) had higher mortality risk in the unadjusted model. After case-mix adjustment, compared to the referent, patients with lower globulin had lower mortality risk while higher globulin still had higher mortality risk. After adjustment for MICS covariates, the associations were attenuated; however, patients with globulin >3.8 g/dL still had a higher mortality risk compared to the referent [figure1].

Conclusion

Among incident hemodialysis patients, higher globulin level is associated with higher mortality risk, independent of other markers of malnutrition and inflammation, including albumin.

Funding

  • NIDDK Support